Showing papers in "Journal of Aging and Health in 1993"
TL;DR: In this paper, a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index was conducted in a multisite survey of persons 65 and older.
Abstract: Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.
1,949Â citations
TL;DR: Self-rated health status and experience of previous falls were significantly associated withFear of falling, and analysis suggests that fear of falling may affect social interaction, independent of risks for falling.
Abstract: To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.
440Â citations
TL;DR: Interventions directed at the risk factors identified here may hold promise for extending independent physical functioning in old age.
Abstract: This study analyzes risk factors associated with 6-year change in physical functioning for 356 members of the Alameda County Study aged 65 and over. Statistically significant associations were found for baseline age, family income, perceived health, number of chronic conditions, prevalent stroke, prevalent heart attack, exercise, going out, marital status, social networks, depression, and internal health locus of control. Relatively strong (but not statistically significant) associations were found for ethnicity, smoking, and weight. Incident conditions during follow-up that had statistically significant associations with change in function included hip fracture, stroke, serious fall, and heart attack. Controls for prevalent and incident conditions attenuated the associations for only ethnicity, smoking, weight, and marital status. Interventions directed at the risk factors identified here may hold promise for extending independent physical functioning in old age
253Â citations
TL;DR: Examination of change over 2 years in ability to perform 21 specific functions among Americans 70 years of age and over finds decline in abilityto perform specific functions is more likely when general health and functioning levels are lower and when a person has had a stroke, has arthritis, or has visual or auditory impairment.
Abstract: This article examines change over 2 years in ability to perform 21 specific functions among Americans 70 years of age and over. Health change in old age is two-directional. Ability to perform specific functions improves for some and deteriorates for others. In addition, many individuals experience both types of functioning change at the same time—improvement in the ability to perform some functions and deterioration in ability to perform others. The covariates of functional improvement differ from those of functional loss. The return to functioning is most likely to occur when the overall functional status of the individual is higher, when the loss has been recent, and when the impairment is not severe. Decline in ability to perform specific functions is more likely when general health and functioning levels are lower and when a person has had a stroke, has arthritis, or has visual or auditory impairment. Age, race, and sex are related to the likelihood that functioning will deteriorate, but they have lit...
165Â citations
TL;DR: In this paper, the hypothesis that stronger self-efficacy beliefs are associated with better cognitive performance at older ages was examined in a sample of men and women, age 70-79.
Abstract: The hypothesis that stronger self-efficacy beliefs are associated with better cognitive performance at older ages was examined in a sample of men and women, age 70-79. Multiple domains of efficacy beliefs and cognitive abilities were examined. Analyses revealed considerable specificity in the observed associations. For men, multiple regression analyses revealed that instrumental efficacy beliefs were related to better performance on tests of memory and abstraction, independent of sociodemographic characteristics and physical and psychological health; there were no independent associations with individual tests of spatial ability naming, incidental recall, or delayed spatial recognition. For women, instrumental efficacy beliefs had no significant associations with the tests of cognitive ability. Interpersonal efficacy beliefs showed no significant associations for men or women. Possible reasons for these gender differences as well as the specificity of the instrumental efficacy associations are discussed.
91Â citations
TL;DR: It was found that incongruence was more likely to be in the form of more favorable, rather than less favorable, ratings, and even among ill elders, those who overestimated their health were less likely to die than were those who did not.
Abstract: Subjective ratings of health are not always congruent with other health indices. The present study explored the congruence/incongruence between subjective overall health ratings and diseases/health...
84Â citations
TL;DR: In this article, the authors studied the relationship between physical functioning and cumulative measures of behavioral and psychosocial risk factors collected over two decades for 91 persons 80 years old and old.
Abstract: The authors studied the relationships between physical functioning and cumulative measures of behavioral and psychosocial risk factors collected over two decades for 91 persons 80 years old and old...
83Â citations
TL;DR: In this article, the associations of maintaining good self-rated health with various independent variables are examined using data from the Ontario Longitudinal Study of Aging, and the strongest association is observed between a life satisfaction index and remaining in good health, and different explanations are suggested for this finding.
Abstract: Using data from the Ontario Longitudinal Study of Aging, the associations of remaining in good self-rated health with various independent variables are examined. Indicators of an "advantaged" socioeconomic status (e.g., relatively high levels of income and education), not smoking, and moderate alcohol use are associated with remaining in good health. The strongest association is observed between a life satisfaction index and remaining in good health, and different explanations are suggested for this finding. Comparisons with the previously reported associations of these same independent variables with mortality show different relationships for the two end points. For example, the associations of several indicators of social relationships with maintaining good self-rated health are not significant, although a strong relationship between social isolation and mortality has been reported. These differences can be explained by assuming that the relationships with the maintenance of good self-rated health can b...
79Â citations
TL;DR: A restructuring of the advance directives process is proposed to accommodate elderly persons' wishes to authorize family members for surrogate health decision making, a policy that would assist the majority of people, including those who either wish to avoid or fail to execute advance directives.
Abstract: Although advance directives for health care are widely advocated, usage rates among the elderly are low Reported is a study testing comparative educational strategies to increase the use of advance directives among elderly persons ages 65 to 93 Follow-up interviews (n = 293) with intervention participants and controls showed that only 1 of 6 different strategies increased use Neither lack of information nor simple procrastination were found as primary barriers to completion of advance directives Most intervention participants preferred to defer to family surrogates and avoid executing advance directives Level of education was a factor in use Proposed is a restructuring of the advance directives process to accommodate elderly persons' wishes to authorize family members for surrogate health decision making, a policy that would assist the majority of people, including those who either wish to avoid or fail to execute advance directives
77Â citations
TL;DR: Using the modified Andersen framework and multiple group discriminant analysis, results show that care recipients who do not use services and those using only in-home services have inadequate informal supports, more emotionally strained caregivers, and more functionally impaired care recipients compared with users of out-of-home or both in- and out- of- home services.
Abstract: Few studies have examined whether the use of different types of services is predicted by different characteristics of elderly care recipients and primary kin caregivers. Most research aggregates services into a single category, thereby assuming that different services have the same predictors. This investigation differs from the aggregation approach by comparing four groups of elderly care recipients: in-home service of users, out-of-home service users, users of both in- and out-of-home services, and those who do not use services. Data come from personal interviews with 171 family caregivers of mild to moderate dementia patients who reside in the community. Using the modified Andersen framework and multiple group discriminant analysis, results show that care recipients who do not use services and those using only in-home services have inadequate informal supports, more emotionally strained caregivers, and more functionally impaired care recipients compared with users of out-of-home or both in- and out-of-home services.
68Â citations
TL;DR: Perceived health barriers predicted the likelihood of dying within 12 years, even after controlling for initial health status, age, gender, income, and education, and subsequent analyses indicated that the PHB-mortality association was not significant among elders who began the study in good health.
Abstract: Gerontologists have become increasingly concerned about the long-term implications of perceived barriers to health, the most often studied barrier being perceived loss of control. Using data from a large-scale longitudinal project, the Aging in Manitoba Studies, the present study (N= 4,317) examined perceived barriers in the management of health problems. Three types of perceived health barriers (PHBs) were considered: control barriers (perceived lack of control over health care and inability to manage health), personal barriers (language and memory deficits), and societal barriers (transportation and financial problems). PHBs were examined as predictors of mortality 12 years later. Control and personal barriers predicted the likelihood of dying within 12 years, even after controlling for initial health status, age, gender, income, and education. Subsequent analyses further indicated that the PHB-mortality association was not significant among elders who began the study in good health
TL;DR: G gaps in doctor-patient communication potentially reduce the effectiveness of medical care by failing to address symptoms of treatable conditions that impact functional status and quality of life.
Abstract: In this study of 100 diabetes patients 60 years old or older making return medical visits, 56% of patients reported one or more important medical problems that were never raised with their doctor. Sixty percent of patients reported important psychosocial problems that were never raised. One quarter of all patients were not able to raise even modest agendas of medical problems during the visit. These gaps in doctor-patient communication potentially reduce the effectiveness of medical care by failing to address symptoms of treatable conditions that impact functional status and quality of life.
TL;DR: This paper examined interpretations of symptoms experienced by a probability sample of older people living in community settings, and found that people who experience few symptoms and assess their health positively are more likely to normalize and minimize the potential import of new or unfamiliar symptoms.
Abstract: This article examines interpretations of symptoms experienced by a probability sample of older people living in community settings. Four assessments were included: seriousness, pain or discomfort, interference with desired activities, and causal attributions. Data were collected through structured interviews and daily diaries completed by a probability sample of 667 older people living in a four-county region of upstate New York. Although few respondents believed their symptoms were definitely serious, the majority experienced some uncertainty regarding the potential seriousness of at least one of their symptoms. Three fourths of these respondents incorporated a medical interpretation in explaining their symptoms; medical interpretations, however, were often used in conjunction with a nonmedical interpretation. The analysis indicated that people who experience few symptoms and assess their health positively are more likely to normalize and minimize the potential import of new or unfamiliar symptoms
TL;DR: It is suggested that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.
Abstract: Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4 years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9-5.3) and 4 years (OR 2.6; 1.6-4.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.
TL;DR: The results suggest that an accurate portrayal of the oldest old requires a multidimensional approach in which the interrelations among domains of functioning are taken into account.
Abstract: Using a multidimensional approach, we explore rates of co-disability in a representative sample of the oldest old living in Sweden. Drawing from census data, 324 subjects ranging in age from 84 to 90 were identified and evaluated for five domains of functioning: sensory, mobility, physical activities of daily living (PADL), instrumental activities of daily living (IADL), and cognitive. Three patterns of functioning were found: (1) a minority of high-functioning subjects (23%) with no or only mild disability in any domain; (2) a group (17%) with IADL deficits only; and (3) a majority of subjects (55%) with multiple disabilities. These results suggest that an accurate portrayal of the oldest old requires a multidimensional approach in which the interrelations among domains of functioning are taken into account Of particular relevance for planning services and care is the heterogeneity of this population, which necessitates a flexible mix of supportive programs that match the resources and abilities of the i...
TL;DR: In this paper, the authors present evidence of a Black/White crossover in functional health, which supports the hypothesis that older members of socially disadvantaged populations are relatively more physiologically robust and thus exhibit relatively favorable functional capacities.
Abstract: This article presents evidence of a Black/White crossover in functional health. Its existence supports the hypothesis, based on selective survival, that older members of socially disadvantaged populations are relatively more physiologically robust and thus exhibit relatively favorable functional capacities. Longitudinal data on 5,150 persons 70 years of age and older shows that within young-old age groups, Blacks are more likely to experience functional status decline over a 6-year period than Whites, whereas within oldest-old age groups, Blacks are less likely to experience decline. The authors also provide confirmation or modification of several hypotheses implicit in the literature on aging, race, and functional health. They find support for the hypothesis that racial differences in age-related changes in mean levels of functional health (i.e., self-care capacity and physical functioning) are age dependent, but do not find support for the hypothesis that social class fully accounts for racial differenc...
TL;DR: Results indicated that self-reports of musculoskeletal conditions by the elderly capture the vast majority of persons with painful or functionally significant disease and are most valid for persons from ages 65 to 74 but do not reflect the presence of asymptomatic joint pathology.
Abstract: This study examined the extent and nature of bias associated with self-reported versus standardized physician-examination/assessment-based accounts of musculoskeletal disease in a sample of 406 persons chosen to represent an aging and dependency continuum. Prevalence of musculoskeletal disease based on standardized physician examination/assessments was 97%. Using the standardized findings as the criterion, the self-report underestimated prevalence by 16%. Overall, the results indicated that self-reports of musculoskeletal conditions by the elderly capture the vast majority of persons with painful or functionally significant disease and are most valid for persons from ages 65 to 74 but do not reflect the presence of asymptomatic joint pathology. Standardized physician examinations/assessments would more accurately determine the presence of risk factors in epidemiological studies of musculoskeletal disability.
TL;DR: In this paper, the authors addressed the dimensionality and construct validity of physical functional capacity within the context of performance-based measures, and indicated that physical functioning in older persons is a multidimensional construct.
Abstract: This study addressed the dimensionality and construct validity of physical functional capacity within the context of performance-based measures. Sixty-two individuals (M= 70yrs), classified as "healthy" based on several screening procedures, completed a battery of standard neuromuscular and physical performance tests. Scores were submitted to a principal components factor analysis to examine and describe potential dimensions of physical functional capacity. Orthogonal and oblique rotations of axes were performed. Six interpretable and meaningful factors were extracted from the orthogonal rotation and identified as strength, unimanual dexterity, mobility/agility, static balance, general upper-extremity control, and movement planning speed. The results indicated that physical functioning in older persons is a multidimensional construct. Moreover, assessment techniques involving performance-based measures should be designed to diagnose physical functional status in separate motor dimensions and plan interven...
TL;DR: It is suggested that women who have never had a mammogram may require more intensive interventions to encourage them to obtain mammograms and might benefit from individual or small group educational sessions where negative attitudes about mammography could be explored and modified.
Abstract: Although breast cancer risk increases with age, most studies show that mammography use decreases. A 15-minute telephone survey of 548 women health maintenance organization (HMO) members aged 65 to ...
TL;DR: Perceived definitions of the concept of good health for age peers and for younger age groups are examined, and the relationship between various definitions and perceived health status, life satisfaction, and service utilization are explored.
Abstract: Although the gerontological literature abounds with references to health status, the meaning of good health to older adults is not readily apparent. Drawing on data from a random sample of 743 individuals aged 65 and over residing in Winnipeg, Manitoba, Canada, perceived definitions of the concept for age peers and for younger age groups are examined. These definitions include a general feeling of well-being, the absence of symptoms, and being able to do usual activities. The extent of congruency in the definitions for different age groups is also considered. Attempts to identify associated sociodemographic characteristics, health status, and health beliefs are largely unsuccessful, although one's own health situations appears important to consider. The relationship between various definitions and perceived health status, life satisfaction, and service utilization are explored. Directions for future research are discussed.
TL;DR: This paper found that respondents did not recall all the kinds of help they received, nor report their health as the basis for needing assistance, and replies to a variety of functional status items were often conditional upon the circumstances.
Abstract: Intensive interviews were conducted with 36 older people, using think aloud and cognitive probes, to study response errors in measuring functional status in health surveys. Consistent with the original hypothesis, words or phrases, such as "aids," "help from another person," and "difficulty," were not interpreted by respondents to have the same meaning as intended. Similarly, evidence was obtained indicating that the subjects did not recall all the kinds of help they received, nor report their health as the basis for needing assistance. Moreover, replies to a variety of functional status items were often conditional upon the circumstances. Recommendations for questionnaire design and further research are discussed.
TL;DR: Results suggest that the factors that influence site of death are necessarily quite distinct for those who have entered the institutional long-term care system versus those who has not and among institutionalized patients, the incidence of an acute condition appears to precipitate hospitalization.
Abstract: Using the 1986 National Mortality Followback Survey (N = 2, 090), this research examines the conditions under which the oldest old (85+ years of age) are discharged from a nursing home to enter and die in a hospital as well as the conditions under which community dwellers enter and die in a hospital. Given the need to plan for health services for this growing population and the recent policy changes in length of hospital stay, this analysis focuses on pathways leading to a hospital death. Results suggest that the factors that influence site of death are necessarily quite distinct for those who have entered the institutional long-term care system versus those who have not. Among institutionalized patients, the incidence of an acute condition appears to precipitate hospitalization, whereas among community dwellers, the presence of a social support network and the decedent's race are the only salient factors predicting hospital death. Implications are discussed.
TL;DR: This research supports the view that instrumental disabilities do put pressure on older persons to change their residence but that the availability of family caregiving is a major buffer to moving, and provides support for the Litwak-Longino model of elderly migration.
Abstract: Using data from the 1984 and 1986 waves of the Longitudinal Study of Aging produced by the National Center for Health Statistics, the authors examined the probability of geographic mobility that is associated with declining levels of instrumental disabilities, while controlling for instrumental interpersonal resources and economic resources. This research concerning health and geographic mobility supports the view that instrumental disabilities do put pressure on older persons to change their residence but that the availability of family caregiving is a major buffer to moving. Family income, however, has no independent effect on mobility in the face of declining functional health. These findings provide support for the Litwak-Longino model of elderly migration
TL;DR: In this article, two models of stress buffering were tested to examine how older women living alone adapted to the stresses in their daily lives and found that the perceived support and enacted support moderated the effect of stressors for psychological distress.
Abstract: This research tested two models of stress buffering to examine how older women living alone adapted to the stresses in their daily lives. No support was found for the suppressor model, but some support for the moderator model of stress buffering. Both perceived support and enacted support moderated the effect of stressors for psychological distress. Confidants were an important source of support for these older women. Both the perception that a friend was available with whom they could discuss their problems and the frequency of confiding moderated the negative impact of stress for psychological distress. Although confidants were a significant source of support for both Black and White women, support from relatives and friends moderated the effect of stressors only for Black women. Black women experienced greater economic hardship and more functional limitations than White women, but they draw on multiple sources of support to adapt to those stressors.
TL;DR: Failure to have prescriptions filled was significantly greater among Black elderly with higher levels of anxiety, those with lower levels of internal health locus of control, those who did not have prescription medication coverage through Medic-aid, Those who were currently using prescription medications, thoseWho consumed greater numbers of over-the-counter medications, and those who reported more financial problems.
Abstract: Despite extensive research on drug consumption and compliance with drug regimens within the geriatric population, little attention has been given to the failure to have prescriptions filled among elderly in general and Black elderly in particular. The prevalence and correlates of patients' failure to have prescriptions filled were investigated for a sample of 571 Black elderly. In terms of prevalence, 12.8% of this sample asserted that they had received a prescription from a physician and not had it filled during the 6 months period prior to interview. Multivariate logistic regression was employed to detect the significant predictors of this type of noncompliance. According to our data, failure to have prescriptions filled was significantly greater among Black elderly with higher levels of anxiety, those with lower levels of internal health locus of control, those who did not have prescription medication coverage through Medic-aid, those who were currently using prescription medications, those who consume...
TL;DR: Analysis of the association between husband's health and the mental health of community-dwelling White women 65 to 75 years of age and how the wife's health, socioeconomic and social resources, and marital quality affect this relationship indicates that the negative association of illness in a spouse on wife's mental state is, in part, a function of the impacthusband's health has on marital intimacy and shared pursuits.
Abstract: This study examines the association between husband's health and the mental health of community-dwelling White women 65 to 75 years of age and how the wife's health, socioeconomic and social resources, and marital quality affect this relationship. Husband's health strongly predicts wife's mental health; the negative impact of which is more pronounced when the wife has poor or declining health as well. Marital quality is a strong predictor of the wives' mental health. Analyses examining the independent and joint effects of marital quality and husband's health on wife's mental health indicate that the negative association of illness in a spouse on wife's mental state is, in part, a function of the impact husband's health has on marital intimacy and shared pursuits. Of the socioeconomic and social resources examined, only availability of close friends shows a substantial relationship to the wives' mental health.
TL;DR: Medium- and long-stay residents of VA nursing homes most resembled "short-" and "long-stay" residents among non-VA nursing home residents, respectively.
Abstract: To examine the patterns and determinants of length of stay among residents of nursing homes of the Department of Veterans Affairs (VA), the authors conducted a retrospective follow-up study of all persons (n = 4,918) admitted to VA nursing homes between October 1986, and April 1987, using computerized records of the VA. Brief-stay ( 6 months; n = 1,832) were older and more functionally impaired than other residents. Medium- and long-stay residents of VA nursing homes most resembled "short-" and "long-stay" residents among non-VA nursing home residents, respectively. Brief-stay residents may be persons admitted for "respite" services or may be serial users of both VA and non-VA health services. Further stud...
TL;DR: The data did not indicate age differences in bilateral diagnostic mammography, performance of hormone receptor assays, radiation therapy, and stage-appropriate treatment, but tumor staging and axillary node dissection did differ by age with significant negative trends in the multivariate model.
Abstract: This article describes the effect of age on the pattern of access to breast cancer care among rural women diagnosed in 1986-1989. Cases were identified by the Illinois State Cancer Registry and information on breast cancer management was obtained through review of hospital records and physician survey. Case follow-back was more than 99% complete. State-of-the-art breast cancer management was defined by the Physician Data Query (PDQ) and included diagnostic evaluation, prognostic evaluation, and stage-specific definitive treatment. The data did not indicate age differences in bilateral diagnostic mammography, performance of hormone receptor assays, radiation therapy, and stage-appropriate treatment. Tumor staging and axillary node dissection did differ by age with significant negative trends in the multivariate model. Also, women younger than 55 years were the most likely to receive separate diagnostic biopsy, limited surgery, and chemotherapy, whereas women 55 to 74 years were most likely to receive hormo...